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PubMed1995

Renal replacement therapy in Canada: a report from the Canadian Organ Replacement Register.

We report here the demography and results of renal replacement therapy in Canada from 1981 to 1992. The new case rate for patients entering renal replacement therapy programs in Canada has increased dramatically over the last 12 years, from 49.9 per million to 98.4 per million of the population. The largest increases have been among the elderly, from 146.2 per million in 1981 to 381.9 per million in 1992 for those aged 65 to 74 years. There has been an even more dramatic increase for those over 75 years, from 83.6 per million in 1981 to 261.6 per million in 1992. There has been a similar increase in the prevalence rate, with an increase from 229.1 per million in 1981 to 518.5 per million in 1992. The hemodialysis rate for 1992 was 172.2 per million and that for peritoneal dialysis was 103.1 per million of the population. The renal transplantation rate also increased from 20 per million in 1981 to 34.8 per million in 1988, but unfortunately has decreased to 27.5 per million in 1992. Diabetes is now the most common primary renal diagnosis, having increased from 15% in 1981 to 24% in 1992. The 5-year survival rate of all patients on renal replacement therapy was 55%. For nondiabetic patients, the 5-year survival rate ranged from 85% for the those aged 15 to 44 years to 20% for those over 65 years. Among diabetic patients, the 5-year survival rate declined from 58% for the 15 to 44 year age group to 10% for those over 65 years.

Adolescent↗
PubMed1986

The weight of evidence: regulatory toxicology in Canada.

The legislative application of regulatory toxicology in Canada is reviewed, together with the sources of experimental evidence used for action. Examples are given of the critical toxicological information that led to a regulatory decision. Risk numbers have only been used to a limited extent in Canada. Some possibilities for future research are offered.

Amaranth Dye↗
PubMed1985

Supply projections as planning: a critical review of forecasting net physician requirements in Canada.

This study involves a critical review of the current methods used to establish net future physician manpower requirements in Canada. The paper explores specific examples of physician manpower forecasting in Canada, and contrasts them with an extensive U.S. exercise completed recently. The conceptual and measurement difficulties inherent in the Canadian methodology are outlined. Particular attention is paid to the various factors that can potentially influence physician requirements but which are omitted from consideration in traditional forecasting. The paper concludes with a discussion of the definition of 'need' in the context of physician requirements.

Canada↗
PubMed1988

Naturopathy in Canada: changing relationships to medicine, chiropractic and the state.

It is said that we can learn as much about social processes from so-called 'deviant' institutions than from the more legitimate. 'Deviant' medical occupations have not attracted much attention from social scientists. Naturopathy is one of these nonconventional health occupations. It emerged in the 18th and 19th centuries and moved to Canada from the United States and Europe early in the 20th. The social history of naturopathy in Canada illustrates the importance of processes of occupational formation and organization as well as state recognition or legitimation. Furthermore, the development of naturopathy shows the importance of state-occupation and naturopathy-chiropractic relationships as well as the often noted relationships with the dominant health occupation of medicine. Incidentally noted are the changing relationships with the state and the dominance of the ideology of science.

Canada↗
PubMed1992

Treatment strategies in advanced and metastatic cancer: differences in attitude between the USA, Canada and Europe.

Six-hundred and forty four radiation therapists from 21 European countries, Canada, and the USA responded to a questionnaire regarding the management of three cases of advanced cancer. The cases were a 64-year-old man with brain metastases from small cell carcinoma of the lung; a 64-year-old woman with bone metastases from carcinoma of the breast and a 59-year-old man with squamous cell carcinoma of the bronchus and mediastinal nodes. There was variation as to the perceived prognosis and appropriate aims of therapy, particularly for the case of squamous cell carcinoma of the bronchus. The total dose and number of fractions could be related to the perceived aims and expectations of treatment, for example, those aiming to extend life gave higher doses of radiotherapy and those aiming only to relieve symptoms gave lower. Similarly, those describing treatment as radical and estimating longer survival gave higher doses and more fractions than those treating palliatively. Variations in the role of the radiation oncologist in the management of advanced and metastatic cancer in the USA, Canada and Europe are discussed.

Attitude of Health Personnel↗
PubMed1989

Prevalence of CS31A and F165 surface antigens in Escherichia coli isolates from animals in France, Canada and India.

Bovine and porcine enterotoxigenic and non-enterotoxigenic Escherichia coli isolates from France, Canada, and India were characterized with respect to serogroup and production of fimbrial antigens CS31A and F165. Of 231 bovine isolates from the 3 countries, 20.5% produced CS31A alone, 17.7% produced F165 alone, and 17.3% produced both CS31A and F165. On the other hand, of 84 porcine isolates from Canada, 1.2% produced CS31A alone, 14.3% produced F165 alone, and no isolate produced both CS31A and F165. CS31A was found together with F5 (K99) in 7 of 16 bovine enterotoxigenic E. coli isolates of serogroups 08, 09, 020, and 023, but was not found in any of 20 F4 (K88)- or 5 F6 (987P)-positive porcine enterotoxigenic E. coli isolates. F165 was not found in enterotoxigenic E. coli. Among non-enterotoxigenic isolates, CS31A and F165 were mainly associated with serogroups 08, 09, 011, 015, 017, 023, 025, 078, 0101, 0115, 0117, 0141, and 0153.

Animals↗
PubMed2005

Motor vehicle collision risk and driving under the influence of cannabis: evidence from adolescents in Atlantic Canada.

OBJECTIVE: Employing a sample of 6087 senior students in Atlantic Canada, this paper examines the relationship between driving under the influence of cannabis (DUIC) and motor vehicle collision (MVC) risk. A series of models were analyzed adjusting for demographic characteristics, driver experience, and substance use. METHODS: Participants were drawn from the 2002/2003 Student Drug Use Survey in the Atlantic Provinces, an anonymous cross-sectional survey of adolescent students in the Atlantic provinces of Canada. Logistic regression techniques were employed in the analysis of unadjusted and adjusted models. RESULTS: Among senior students, the prevalence of DUIC in the past year was 15.1% while the prevalence of MVCs was 8.1%. The predictors of DUIC were gender, driver experience, use of a fake ID, and driving under the influence of alcohol (DUIA). The predictors of MVC were gender, driver experience, DUIC, and DUIA. CONCLUSIONS: These findings extend our knowledge of DUIC as a socio-legal and public health issue with implications on road safety. Effort must be placed on educating new drivers about cannabis use in the context of driving.

Accidents, Traffic↗
PubMed2004

An evaluation of trends in obstetrics and gynecology clerkships in the United States and Canada.

OBJECTIVE: The purpose of this study was to provide an updated profile of clerkship directors and third-year clerkships for Departments of Obstetrics and Gynecology at US and Canadian medical schools. STUDY DESIGN: All 142 accredited medical schools in the US and Canada were contacted to identify the individual(s) responsible for third-year medical education in Obstetrics and Gynecology. Additional clerkship sites (n=10) were identified using the Association of Professors in Gynecology and Obstetrics' (APGO) list of current members self-identified as clerkship directors. Written surveys were mailed to the individuals identified above. The survey included questions about demographic and academic profiles, 11 attitude statements, as well as potential interest in a national organization of clerkship directors under APGO and interest in the creation of web-based resources specifically for clerkship directors. RESULTS: One hundred twenty-three (81%) responses were received. Demographic and academic characteristics of clerkship directors were similar to those published 13 (1) and 6 (2) years ago, except that the proportion of female clerkship directors has steadily increased (20% in 1989 [1], 25% in 1994 [2], and 44% in 2000, P <.0001). Thirty-five percent of departments have a specialized division of medical education, and 21% of respondents stated that their affiliated medical school had a formal multidisciplinary women's health care curriculum. Eighty-nine percent of respondents felt that their job as clerkship director was personally fulfilling. Eighty- nine percent supported a national organization of clerkship directors under APGO and the majority supported other activities specific for clerkship directors, including web-based resources. CONCLUSION: The profiles of obstetrics and gynecology clerkships and clerkship directors in the US and Canada have remained relatively stable over the last 13 years. However, the proportion of female clerkship directors continues to increase. Interest in more organized activities specifically for clerkship directors and web-based resources is high.

Canada↗
PubMed2004

Cytomegalovirus prophylaxis and treatment after hematopoietic stem cell transplantation in Canada: a description of current practices and comparison with Centers for Disease Control/Infectious Diseases Society of America/American Society for Blood and Marrow Transplantation guideline recommendations.

Prevention and management of cytomegalovirus (CMV) disease after hematopoietic stem cell transplantation (HSCT) is critically important, but clinical practices have historically been heterogeneous. The Centers for Disease Control (CDC), as part of a larger clinical practice guideline initiative, has published evidence-based recommendations, but their effect on clinical practice has not been assessed. A survey was sent to all Canadian HSCT program directors to describe current practices. Current practices were subsequently compared with CDC guideline recommendations and with a Canadian survey published before the CDC guidelines. When current practices did not conform to guideline recommendations, a literature review was performed to determine whether current practices were supported by evidence published after the CDC guidelines. The survey response rate was 100%. Variability in practices was observed in several aspects of patient care, including (1) indications for CMV-negative blood products, (2) surveillance tests used to detect CMV infection, (3) duration of surveillance testing, (4) duration of maintenance treatment after preemptive therapy was initiated, and (5) treatment of CMV disease. Overall adherence to guideline recommendations was good, especially when they were supported by high-quality data. However, deviations from guideline recommendations were observed: (1) most Canadian allogeneic programs used shorter courses of preemptive therapy; (2) prevention measures aimed at late CMV disease were not systematically applied at most allogeneic programs; and (3) most autologous HSCT programs did not administer preemptive therapy even in high-risk recipients. When deviations occurred, recent evidence supported current practices in some instances (shorter courses of preemptive therapy) but not in others (absence of strategies to prevent late CMV disease). Compared with practices in Canada before publication of the CDC guidelines, a higher proportion of programs used CDC-recommended surveillance tests and treatment for CMV infection. Current practices in Canada remain heterogeneous. Discrepancies between current practices and CDC guideline recommendations occurred in situations either in which practices had changed in response to recently published data or in which evidence supporting a recommendation was poor. These results suggest an urgent need for the development of well-designed clinical trials. Incorporation of recent data into updated guidelines may be appropriate.

Bone Marrow Transplantation↗
PubMed2005

Biomaterials in Canada: the first four decades.

Biomaterials research in Canada began in the 1960s. Over the past four decades significant contributions have been made across a broad spectrum covering dental, orthopaedic, cardiovascular, neuro, and ocular biomaterials. Canadians have also been active in the derivative area of tissue engineering. Biomaterials laboratories are now established in universities and research institutes from coast to coast, supported mainly by funding from the Federal and Provincial Governments. The Canadian Biomaterials Society was formed in 1971 and has played an important role in the development of the field. The Society played host to the 5th World Biomaterials Congress in Toronto in 1996. The work of Canadian researchers over the past four decades is summarized briefly. It is concluded that biomaterials and tissue engineering is a mature, strong area of research in Canada and appears set to continue as such into the future.

Biocompatible Materials↗
PubMed2006

Potential for hydrogen and methane production from biomass residues in Canada.

Canada generates approximately 1.45 x 10(8)t of residual biomass per year, containing an estimated energy value of 2.28 x 10(9)GJ, which is equivalent to about 22% of Canada's current annual energy use. Anaerobic digestion of these biomass residues using conventional technologies could generate 1.14 x 10(10)m(3)/year of CH(4) with a heating value of 4.56 x 10(8)GJ. Conversion of these residues using emerging technologies that favor the synthesis of H(2) and represses the synthesis of CH(4) could generate 1.47 x 10(10)m(3)/year renewable H(2), with a heating value of 1.89 x 10(8)GJ. While CH(4)-production results in a larger amount of energy recovery, generating H(2) from waste biomass is a renewable alternative that could fuel the hydrogen economy. Additional research to further both the technical and commercial development of microbial bio-energy from biomass is warranted.

Biomass↗
PubMed2005

CAM in Canada: places, practices, research.

This paper reflects on the practice and research of complementary and alternative medicine (CAM) in Canada. Although certain trends in use, as well as the regulation and integration of CAM, are mirrored in many other developed countries, some are highlighted as uniquely Canadian with distinct political and economic geographies. Similarly, although like in other countries the research of CAM is growing rapidly, Canadian scholars have been particularly productive in terms of providing unique disciplinary perspectives and the ways in which they have organized their research training and collaborations. CAM is clearly not a fully integrated and researched option in Canadian health care, yet Canada exhibits the foundations for an integrated CAM practice, supported by a growing, wide-ranging and well-articulated research evidence-base.

Canada↗
PubMed2006

Methicillin-resistant Staphylococcus aureus with reduced susceptibility to vancomycin in Canada.

This study defines the characteristics of decreasing vancomycin susceptibility in multiple isolates of methicillin-resistant Staphylococcus aureus (MRSA) recovered from a hospitalized patient in Canada over a period of 6 months. The MICs of the isolates increased during therapy with vancomycin. The patient fractured her right hip while in the United States. She was started on treatment with vancomycin. The MICs of successive isolates increased from < or =1 to 4 mg/L over 6 months. Then, an isolate tested at 8 mg/L initially and 4 mg/L with confirmatory E-test (AB BIODISK, Solna, Sweden). One month later, MRSA was still present in her wound, and therapy was changed to linezolid with rifampin. Subsequent cultures were negative for MRSA. Susceptibility testing was performed on the BD Phoenix (Becton Dickinson Diagnostic Systems, Sparks, MD), Dade Microscan (Dade Behring Microscan, Sacramento, CA), Pasco MIC (Becton Dickinson, Sparks, MD), Vitek 2 (bioMerieux, St. Louis, MO), and Sensititre (Trek Diagnostic Systems, Cleveland, OH) systems, and by E-test. Molecular typing (pulsed-field gel electrophoresis [PFGE]) was used to verify the relatedness of the isolates. Transmission electron microscopy (TEM) was used to assess the cell wall thickness of isolates with differing MICs. Population analysis was performed to assess for vancomycin hetero-resistance. MICs of 4 mg/L were only obtained with BD Phoenix, E-test, and broth microdilution. All isolates were identical by PFGE. The most resistant isolate had a thicker cell wall on TEM. Vancomycin hetero-resistance was observed in the resistant isolates. This is the first strain of MRSA with reduced susceptibility to vancomycin reported in Canada. The breakpoints for vancomycin susceptibility have been revised in light of such observations.

Anti-Bacterial Agents↗
PubMed2005

Maternal and umbilical cord blood levels of mercury, lead, cadmium, and essential trace elements in Arctic Canada.

Maternal and umbilical cord blood levels of mercury (Hg), lead (Pb), cadmium (Cd), and the trace elements copper (Cu), zinc (Zn), and selenium (Se) are reported for Inuit, Dene/Métis, Caucasian, and Other nonaboriginal participants from Arctic Canada. This is the first human tissue monitoring program covering the entire Northwest Territories and Nunavut for multiple contaminants and establishes a baseline upon which future comparisons can be made. Results for chlorinated organic pesticides and PCBs for these participants have been reported elsewhere. Between May 1994 and June 1999, 523 women volunteered to participate by giving their written informed consent, resulting in the collection of 386 maternal blood samples, 407 cord samples, and 351 cord:maternal paired samples. Geometric mean (GM) maternal total mercury (THg) concentrations ranged from 0.87 microg/L (SD = 1.95) in the Caucasian group of participants (n = 134) to 3.51 microg/L (SD = 8.30) in the Inuit group (n = 146). The GM of the Inuit group was 2.6-fold higher than that of the Dene/Métis group (1.35 microg/L, SD = 1.60, n = 92) and significantly higher than those of all other groups (P<0.0001). Of Inuit women participants, 3% (n = 4) were within Health Canada's level of concern range (20-99 microg/L) for methylmercury (MeHg) exposure. Of Inuit and Dene/Métis cord samples, 56% (n = 95) and 5% (n = 4), respectively, exceeded 5.8 microg/L MeHg, the revised US Environmental Protection Agency lower benchmark dose. GM maternal Pb was significantly higher in Dene/Métis (30.9 microg/L or 3.1 microg/dL; SD = 29.1 microg/L) and Inuit (31.6 microg/L, SD = 38.3) participants compared with the Caucasian group (20.6 microg/L, SD = 17.9) (P < 0.0001). Half of all participants were smokers. GM blood Cd in moderate smokers (1-8 cigarettes/day) and in heavy smokers (> 8 cigarettes/day) was 7.4-fold higher and 12.5-fold higher, respectively, than in nonsmokers. The high percentage of smokers among Inuit (77%) and Dene/Métis (48%) participants highlights the need for ongoing public health action directed at tobacco prevention, reduction, and cessation for women of reproductive age. Pb and THg were detected in more than 95% of all cord blood samples, with GMs of 21 microg/L and 2.7 microg/L, respectively, and Cd was detected in 26% of all cord samples, with a GM of 0.08 microg/L. Cord:maternal ratios from paired samples ranged from 0.44 to 4.5 for THg, from 0.5 to 10.3 for MeHg, and 0.1 to 9.0 for Pb. On average, levels of THg, MeHg, and Zn were significantly higher in cord blood than in maternal blood (P < 0.0001), whereas maternal Cd, Pb, Se, and Cu levels were significantly higher than those in cord blood (P < 0.0001). There was no significant relationship between methylmercury and selenium for the range of MeHg exposures in this study. Ongoing monitoring of populations at risk and traditional food species, as well as continued international efforts to reduce anthropogenic sources of mercury, are recommended.

Adult↗
PubMed2006

Comparative perspectives: regulating preimplantation genetic diagnosis in Canada and the United Kingdom.

Preimplantation genetic diagnosis (PGD) in the United Kingdom is governed by a centralized regulatory agency, while Canada's current approach to regulating PGD is neither integrated nor comprehensive. Though concerns have been raised about state regulation of assisted reproductive technologies (ARTs), Canada's move toward centralized oversight of these technologies will lead to improvements in uniformity and transparency of regulation, and will provide a central forum for policy debate and discussion.

Attitude to Health↗
PubMed2005

Drug coverage in Canada: who is at risk?

Drugs are playing an increasingly important role in health care. However, unlike physician care and hospital care, Canadians do not have universal coverage for drugs. Generally, many employers provide drug coverage as part of employment benefits. In addition, provincial governments provide coverage to some parts of the population, generally, seniors and families on social assistance. Two important recent reports on the state of health care in Canada--the Kirby and Romanow reports--focus on the need for relief to families for rising cost of drugs. Policy makers need good information not only on the likely costs of such a project but also the impact of increasing drug costs on individuals and families with significant drug expenses. One of the keys to assessing scenarios for such relief is knowledge about the extent and depth of existing drug insurance coverage. However, the needed information is scattered over a number of data sources. We have put together a comprehensive and cohesive micro database synthesizing data from these diverse sources. The resultant micro database contains individual/family drug coverage information arrayed by socio-economic characteristics. This paper uses the data set to conduct an extensive analysis of the extent of drug coverage under public and private drug plans in Canada. The paper then goes on to analyze the level of such coverage in terms of out-of-pocket drug expenses faced by Canadian families in an effort to identify gaps in coverage.

Adolescent↗
PubMed2005

Interprovincial migration of physicians in Canada: What are the determinants?

This paper analyzes factors contributing to interprovincial migration of physicians in Canada. It (1) compares the migration patterns of the general practitioners and specialists (medical and surgical); (2) analyzes the changing patterns of out-migration over time via the interactions between the province of residence and time period; (3) analyzes the effect of language as a determinant of migration out of predominantly French speaking Quebec. A logistic formulation of discrete-time hazard model was employed to estimate the probability of moving from the current province of residence. Sets of physician's individual characteristics variables along with dummy variables to reflect the provincial characteristics and various time-periods were included in the model. The model was extended to allow for interaction effects between the province of residence and time-period, and also between language and Quebec (the only province in Canada which is predominantly French speaking) as province of residence. The results suggest that physician's age, specialty, province of residence have significant impact on interprovincial migration of physicians. The probability of moving differs significantly across province of residences in various time-periods.

Adult↗
PubMed2005

The state's role in promoting population health: public health concerns in Canada, USA, UK, and Sweden.

Despite the expanding literature on the importance role public policy plays in influencing the broader determinants of the public's health, profound differences exist among jurisdictions in the attention placed by the State - as represented by public health authorities and agencies - upon such activities. In this paper we examine the dominant public health models of Canada, USA, UK, and Sweden. The Canadian and USA public health communities are focused upon individualized approaches to risk management. In contrast, the UK and Swedish public health scenes are more oriented toward broader approaches to health determinants. We argue that the extent to which governments, public health agencies and public health workers concern themselves with public policy approaches to address broader determinants of health depends upon the particular model of health adhered to within each jurisdiction. And whether a health model is adopted depends upon the ideological and political context within which a nation is situated. Canada represents a situation where concerted effort to influence governmental policy directions by the public health community could reap significant benefits.

Canada↗